Healthcare Provider Details

I. General information

NPI: 1265820393
Provider Name (Legal Business Name): HARMONY COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SAW MILL RD SUITE 3103
LAFAYETTE IN
47905-5592
US

IV. Provider business mailing address

100 SAW MILL RD SUITE 3103
LAFAYETTE IN
47905-5592
US

V. Phone/Fax

Practice location:
  • Phone: 765-414-8227
  • Fax: 310-348-0201
Mailing address:
  • Phone: 765-414-8227
  • Fax: 310-348-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34003983A
License Number StateIN

VIII. Authorized Official

Name: PATRICIA M THORN KISH
Title or Position: PRESIDENT
Credential: MSW,LCSW
Phone: 765-414-8227